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What does a positive caesarean look like?

**Given the nature of the content of this post, there may be some discussion that could be triggering.**

One of the ways I support women preparing for their birth after caesarean is helping them develop a plan for a positive caesarean. This is usually as part of their birth map when we look at the "unexpected" pathway - planning for what will happen if our situation changes and we need to deviate from our expected VBAC pathway. Occasionally, though, the positive caesarean is the expected pathway that we are planning for.

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Now, I also just want to mention quickly that a very, very small percentage of caesareans will be genuinely serious, life-threatening emergencies and in these cases, there is much of the positive caesarean that is simply not feasible. It's very rare that this would happen, but one of the ways we can try to mitigate the risk of birth trauma in such cases is to prepare for it - in these situations, think about what you want it to happen and who will be in charge. Please feel free to get in touch with me if you'd like more help planning this pathway.

In any case, the term 'positive caesarean' can feel like a bit of an oxymoron, but it doesn't have to be. It also doesn't necessarily mean that the experience needs to be euphoric.


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A positive caesarean is really about understanding what options you have and requesting for what is important to you during a surgical birth. And for that reason, a positive caesarean will look a bit different from one person to the next.


For example, you might have some women that want their surgeon to talk them through everything they are doing as they are doing it, whereas other women might find that more unsettling than just having their own music or meditations playing and focusing on that.


I've covered a little bit of this information as part of my "Planning for a caesarean" blog post, but this one is going to focus a little bit of more on the positive caesarean angle. However, I strongly recommend checking that article out as well, because it goes over a number of extra things that this one might not.

I'd recommend that the first step towards planning for a positive caesarean if you have had a caesarean before, is to take the time to process the previous caesarean. Consider what parts were hardest, what you wished had been different. If there are parts of your caesarean that you can feel triggers a strong nervous system response (shivering/shaking, heart palpitations, chest tightness, upside down stomach, or really any number of physical symptoms that happen that you associated with anxiety/panic or just don't seem to have conscious control over), those are the areas that firstly, I'd highly recommend you speak with a birth professional about to debrief and process, but that also will need particularly care in a repeat caesarean.


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To explore the ways we can plan a positive caesarean, I suggest splitting things up into categories based on four of the five senses: sight, sound, smell, and touch. Then there are a number of more practical related things we can consider as well.

Sight:

  • can the lighting be turned down or off (apart from the surgical lamps, for obvious reasons?)

  • do you want to see your baby as they are born, either directly or via a mirror?

  • do you want to announce the sex yourselves if unknown?

  • can you have a second support person present in the theatre, or a photographer?

  • do you want to restrict the number of people in the theatre (for example, students)

  • do you want to see (or even keep) your placenta?


Sound:

  • do you want to have your own music or meditations playing?

  • do you want the surgeon to talk through the procedure as they are doing it?

  • do you have affirmations you would like your support person to recite to you?

  • do you want to wear earplugs and avoid as much noise as possible?


Smell:

(smell can be a very strong trigger for our nervous systems, so please keep in mind that if you have had a traumatic prior caesarean, there may be smells in the operating room that unexpectedly trigger a nervous response)

  • are there some essential oils you would like your support person to hold under your nose throughout?


Touch:

  • can you ask the anaesthetist to dose your spinal or epidural slowly and gradually, testing along the way, for you to be certain you are numb only where you need to be?

  • do you want someone to hold your hand? Stroke your hair? What physical action would you like your support person to do?

  • do you want to have a maternal assisted caesarean, where you pull baby out yourself?

  • do you want your baby to be born via gentle caesarean, allowing them to slowly push themselves out?

  • do you want your baby straight on your chest, skin-to-skin?

  • do you want there to be conditions around baby to being suctioned or wiped down?

  • do you want to initiate breastfeeding in theatre?

  • do you want to remain skin-to-skin through recovery and to the ward?

One other really important consideration is optimal cord clamping for baby. Women are frequently being told that they can't have delayed cord clamping in theatre, and honestly, it's just not acceptable. Some women have even had lotus births via caesarean, so why on earth does the baby's cord need to be cut immediately at birth?

If this is something that is important to you, make sure to be very clear that this is a must and also be very clear about what your definition of delayed/optimal cord clamping is. One of my few regrets from my second unplanned caesarean was that I didn't realise that my definition of delayed cord clamping was different to my surgeon's. This was because in my first caesarean, when I'd requested delayed cord clamping, my surgeon waited for white, so it didn't occur to me to need to clarify with my second baby. I recall hearing them say "okay, that's been a minute, we're going to cut the cord" and before I really had a chance to protest, it was done. A minute is still better than nothing, definitely, but I'm still sad to think that she didn't get her full blood volume at birth when it was something that was so easy to do.

Another thing you can consider is vaginal seeding, which I discuss in the Planning for a Caesarean blog post.

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Finally, a couple of other practical plans to make are if there is a need to be separated, who goes with who? Does Dad go with baby? Who will be with you? If you are otherwise incapacitated for an extended period, how will baby be fed?

Think about planning a positive caesarean by considering what will make you feel in control throughout. Things like walking to the theatre with your partner if you're able, for example, can help you feel you have a sense of agency that it's common to feel you had taken from you in previous caesareans.


Do you have questions? Comments? Leave them below, or get in touch with me if you want help planning for a positive caesarean!

 

My name is Katelyn Commerford and I am a doula and next birth after caesarean guide who has completed comprehensive doula education, dedicated to continuous learning. If you want to know more about what I do and how I can help you, please visit my website (where you can get your free cheat sheet of my favourite VBAC resources!), or find me on instagram @thenbacguide where I answer commonly asked questions about planning the next birth after caesarean and share loads pregnancy, birth, postpartum and parenting content.

Business Name: Katelyn Commerford - Doula and NBAC Guide

Phone: 0431 369 352

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